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Eye (London, England) Sep 2021Blepharoptosis (ptosis) is among the most common disorders of the upper eyelid encountered in both optometric and ophthalmic practice. The unilateral or bilateral... (Review)
Review
Blepharoptosis (ptosis) is among the most common disorders of the upper eyelid encountered in both optometric and ophthalmic practice. The unilateral or bilateral drooping of the upper eyelid that characterises ptosis can affect appearance and impair visual function, both of which can negatively impact quality of life. While there are several known forms of congenital ptosis, acquired ptosis (appearing later in life, due to a variety of causes) is the predominant form of the condition. This review summarises the prevalence, causes, identification, differential diagnosis, and treatment of acquired ptosis. Particular attention is paid to the differential diagnosis of acquired ptosis and emerging treatment options, including surgical and pharmacologic approaches.
Topics: Blepharoplasty; Blepharoptosis; Eyelids; Humans; Prevalence; Quality of Life
PubMed: 33927356
DOI: 10.1038/s41433-021-01547-5 -
Seminars in Ophthalmology May 2010Blepharoptosis is the downward displacement of the upper eyelid secondary to structural abnormalities (muscle or aponeurosis) or neurologic problems. It is a frequent... (Review)
Review
Blepharoptosis is the downward displacement of the upper eyelid secondary to structural abnormalities (muscle or aponeurosis) or neurologic problems. It is a frequent condition and its clinical picture varies from a cosmetic discomfort to severe visual dysfunction, depending on the pathogenesis and the degree of ptosis. The diagnosis of ptosis is complex and goes beyond simple clinical examination. Ptosis surgery is perhaps the most challenging in the field of oculoplastics, especially in congenital cases and neuromuscular disorders. This paper discusses some concepts in blepharoptosis with emphasis on diagnosis and surgical principles.
Topics: Blepharoptosis; Humans
PubMed: 20590412
DOI: 10.3109/08820538.2010.496695 -
Current Opinion in Otolaryngology &... Aug 2003Blepharoptosis is a common complaint of eyelid malposition in which the upper eyelid is lower than normal. There are multiple types of blepharoptosis based on cause, and... (Review)
Review
Blepharoptosis is a common complaint of eyelid malposition in which the upper eyelid is lower than normal. There are multiple types of blepharoptosis based on cause, and important studies have recently been published on one type, myogenic blepharoptosis. There have classically been three methods for correcting blepharoptosis. For the most severe cases, frontalis slings are often performed. New materials, such as polyester mesh, have shown promise as alternatives in forming frontalis slings. A recent paper has suggested a new algorithm for another method of blepharoptosis correction, the conjunctiva-Müller muscle resection. The effectiveness of the third type of procedure for blepharoptosis correction, the external levator advancement, has been reinforced in a study examining the procedure in cases of congenital blepharoptosis.
Topics: Blepharoplasty; Blepharoptosis; Humans
PubMed: 14515075
DOI: 10.1097/00020840-200308000-00009 -
Current Opinion in Ophthalmology Jan 2016To evaluate the incidence of blepharoptosis following ocular surgical procedures, to elucidate mechanisms for its cause, and to identify potential risk factors for... (Review)
Review
PURPOSE OF REVIEW
To evaluate the incidence of blepharoptosis following ocular surgical procedures, to elucidate mechanisms for its cause, and to identify potential risk factors for ocular surgeons to avoid.
RECENT FINDINGS
Postoperative blepharoptosis has been a poorly understood concept. In the search for a definitive cause, various technical components of surgery have been implicated. Recent research highlights the importance of individual anatomy and proposes new mechanisms for postoperative ptosis, including excessive eyelid tension from specula, topical prostaglandin analogue use, and direct trauma at the level of the tarsal plate.
SUMMARY
Blepharoptosis is common following ocular surgery and can occur through multiple mechanisms. Certain individuals are at a higher risk for postoperative blepharoptosis, but all surgeons and patients undergoing ocular surgery should understand this risk when providing informed consent. Operative techniques can be adjusted to decrease rates of postoperative blepharoptosis.
Topics: Animals; Blepharoptosis; Eyelids; Humans; Incidence; Postoperative Complications; Risk Factors
PubMed: 26632916
DOI: 10.1097/ICU.0000000000000218 -
Neurological Sciences : Official... Oct 2016Blepharoptosis or drooping of upper eye lid is a common, but non-specific sign of neurological diseases which sometimes could herald a life-threatening disorder. First,... (Review)
Review
Blepharoptosis or drooping of upper eye lid is a common, but non-specific sign of neurological diseases which sometimes could herald a life-threatening disorder. First, the diagnosis of ptosis should be established by considering four clinical measurements: palpebral fissure height, marginal reflex distance, upper eyelid crease, and levator function test. The diagnostic categories of ptosis are scheduled as pseudo-ptosis, congenital, and acquired ptosis. Acquired causes include mechanical, myogenic, neuromuscular, neurogenic, and cerebral. Each category with diseases presenting with ptosis was described in detail. Considering some features, such as involvement of other cranial nerves, extraocular muscle, pupil size and reactivity, and unilateral or bilateral presentation of ptosis, could help to narrow the differential diagnosis.
Topics: Blepharoptosis; Diagnosis, Differential; Humans; Oculomotor Muscles
PubMed: 27329276
DOI: 10.1007/s10072-016-2633-7 -
Insight (American Society of Ophthalmic... 2015
Review
Topics: Blepharoplasty; Blepharoptosis; Diagnostic Techniques, Ophthalmological; Disease Management; Humans
PubMed: 26897787
DOI: No ID Found -
Facial Plastic Surgery : FPS Aug 2022Drooping of the upper eyelid margin, aka blepharoptosis or "ptosis," is common. Whether the ptosis is severe or mild, congenital or acquired, aponeurotic or neuropathic...
Drooping of the upper eyelid margin, aka blepharoptosis or "ptosis," is common. Whether the ptosis is severe or mild, congenital or acquired, aponeurotic or neuropathic or myopathic, proper management always begins with a detailed history and evaluation of the patient. The information gathered will direct the surgeon in choosing the technique most likely to give the best result. This article will briefly review common causes of ptosis, the evaluation of the ptosis patient as well as the two most common types of surgical intervention.
Topics: Humans; Blepharoptosis; Eyelids; Oculomotor Muscles; Blepharoplasty
PubMed: 35654403
DOI: 10.1055/a-1868-0986 -
Aesthetic Plastic Surgery 2003Drooping of the upper eyelid (upper eyelid ptosis) may be minimal (1-2 mm), moderate (3-4 mm), or severe (>4 mm), covering the pupil entirely. Ptosis can affect one or... (Review)
Review
Drooping of the upper eyelid (upper eyelid ptosis) may be minimal (1-2 mm), moderate (3-4 mm), or severe (>4 mm), covering the pupil entirely. Ptosis can affect one or both eyes. Ptosis can be present at birth (congenital) or develop later in life (acquired). Ptosis may be due to a myogenic, neurogenic, aponeurotic, mechanical or traumatic cause. Usually, ptosis occurs isolated, but may be associated with various other conditions, like immunological, degenerative, or hereditary disorders, tumors, or infections. Besides drooping, patients with ptosis complain about tired appearance, blurred vision, and increased tearing. Patients with significant ptosis may need to tilt their head back into a chin-up position, lift their eyelid with a finger, or raise their eyebrows. Continuous activation of the forehead and scalp muscles may additionally cause tension headache and eyestrain. If congenital ptosis is not corrected, amblyopia, leading to permanently poor vision, may develop. Patients with ptosis should be investigated clinically by an ophthalmologist and neurologist, for blood tests, X-rays, and CT/MRI scans of the brain, orbita, and thorax. Treatment of ptosis depends on age, etiology, whether one or both eyelids are involved, the severity of ptosis, the levator function, and presence of additional ophthalmologic or neurologic abnormalities. Generally, treatment of ptosis comprises a watch-and-wait policy, prosthesis, medication, or surgery. For minimal ptosis, Müller's muscle conjunctival resection or the Fasanella Servat procedure are proposed. For moderate ptosis with a levator function of 5-10 mm, shortening of the levator palpebrae or levator muscle advancement are proposed. For severe ptosis with a levator function <5 mm, a brow/frontalis suspension is indicated. Risks of ptosis surgery infrequently include infection, bleeding, over- or undercorrection, and reduced vision. Immediately after surgery, there may be temporary difficulties in completely closing the eye. Although improvement of the lid height is usually achieved, the eyelids may not appear perfectly symmetrical. In rare cases, full eyelid movement does not return. In some cases, more than one operation is required.
Topics: Blepharoplasty; Blepharoptosis; Eyelids; Humans; Oculomotor Muscles; Severity of Illness Index; Surgical Flaps; Treatment Outcome
PubMed: 12925861
DOI: 10.1007/s00266-003-0127-5 -
Optometry and Vision Science : Official... Mar 2022Acquired ptosis is a condition of the upper eyelid that has negative cosmetic and functional effects but is likely underdiagnosed and undertreated. Given the evolving... (Review)
Review
Acquired ptosis is a condition of the upper eyelid that has negative cosmetic and functional effects but is likely underdiagnosed and undertreated. Given the evolving understanding of the condition and expanding therapeutic options, this review reappraised published evidence and clinical experience regarding diagnosis and treatment of acquired ptosis.The authors met over two structured virtual working sessions to review current evidence and develop timely recommendations for acquired ptosis identification, differential diagnosis, characterization, and treatment selection. Diagnostic algorithms, plus management and referral guidelines, are presented. Eyelid evaluation and, when needed, ptosis diagnostic workup are essential in the comprehensive eye examination. Acquired ptosis can be efficiently identified via patient questionnaire, history, and photograph review combined with assessment of eyelid position and symmetry using established methods. When ptosis is present, it is essential to evaluate onset, symptoms, pupil diameter, and extraocular muscle function to identify or rule out serious underlying conditions. If signs of serious underlying etiology are present, immediate referral/follow-up testing is required. After ruling out serious underlying causes, masquerade conditions, and pseudoptosis, pharmacologic or surgical treatment should be selected based on the clinical evidence. Effectively managing acquired ptosis requires practice-wide commitment to thorough eyelid evaluation, accurate diagnosis, and adoption of new treatment modalities. Aided by evolving pharmacologic therapeutic options, shifting from a "detect and refer" to a "diagnose and manage" approach can support identification and treatment of more patients with acquired ptosis, particularly mild-to-moderate cases.
Topics: Algorithms; Blepharoptosis; Eyelid Diseases; Eyelids; Humans; Oculomotor Muscles
PubMed: 35058403
DOI: 10.1097/OPX.0000000000001868 -
Current Opinion in Ophthalmology Oct 1999Blepharoptosis is a relatively common condition that is frequently encountered by the ophthalmic surgeon. Treatment remains somewhat unpredictable, and the choice of one... (Review)
Review
Blepharoptosis is a relatively common condition that is frequently encountered by the ophthalmic surgeon. Treatment remains somewhat unpredictable, and the choice of one of the various surgical options depends on the cause of the ptosis and the amount of levator function. Recent contributions to the literature on the classification and management of ptosis are reviewed here.
Topics: Blepharoplasty; Blepharoptosis; Humans; Treatment Outcome
PubMed: 10621548
DOI: 10.1097/00055735-199910000-00010